A checklist of nine strategies and guidance for state Medicaid agencies assisting school systems with Medicaid reimbursements for students' school-based health services is now available from the U.S. Department of Health and Human Services.
While schools primarily provide education, school settings offer a "unique opportunity" to enroll children and teens in Medicaid and the Children's Health Insurance Program and provide Medicaid-covered services, including mental health services, said Daniel Tsai, deputy administrator and director of the Center for Medicaid and CHIP Services at HHS, in a CMCS information bulletin last month.
"Schools are uniquely positioned to increase health equity and to help ensure that all children have access to necessary health care services," Tsai said.
The checklist includes a variety of recommendations for services and reimbursement management practices, as well as explanations and clarifications of existing rules.
For example, the bulletin explains that the Medicaid "free care" policy could apply when a school nurse administers fluoride treatment to the entire student body, as long as that nurse or the school is enrolled as a Medicaid provider. This means the fluoride treatment could be eligible for Medicaid payment.
Only 16 states, however, allow districts to seek reimbursements for school-based health services for all Medicaid-eligible students. All districts currently are able to seek reimbursement for healthcare services provided to Medicaid-eligible special education students.
Other points of explanation in the bulletin include Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, telehealth delivery services, and best practices for documentation requirements.
In another bulletin issued by CMCS, Tsai explains the USDA Food and Nutrition Service is calling for participation in additional demonstration projects for states to evaluate the impact of using Medicaid eligibility data to directly qualify students for free and reduced-price school meals.
The bulletins are part of a series of resources planned by HHS to simplify, expand and improve the school-based Medicaid services process. HHS is working with the U.S. Department of Education on some of the initiatives. Advocates and educators have said cumbersome, outdated and unclear rules have made the Medicaid reimbursement process challenging for some school systems.
Less than 1% of total Medicaid spending is for school-based services, but it is the third or fourth largest federal revenue stream for school systems, according to a March presentation from the Medicaid in Schools Coalition.
The coalition also said nearly 40% of school-age children receive health coverage through Medicaid or through CHIP. AASA, The School Superintendents Association estimates Medicaid reimbursements to schools to be about $3 billion to $4 billion.